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t <br />Laboratories Inc.; <br />Environmental Testing Laboratory Since 1949 <br />I <br />it <br />illl <br />1 <br />Chain of Custody and Cooler Receipt Form for 1203360 Page 2 of 2 <br />ec LABORATORIES INC. <br />SAMPLE RECEIPT FORM Rev. No. 12 @srzar@s Page 1 O,i_ <br />Submission #: '0�J <br />C - r <br />SHIPPING INFORMATION <br />Federal Express ❑ UPS ❑ Hand Delivery ❑ <br />BC Lab Field Service W Other ❑ (Specify) <br />SHIPPING CONTAINER <br />Ice Chesty None ❑ <br />Box ❑ Other ❑ (Specify) <br />Refrigerant: Ice - Blue Ice ❑ None ❑ Other ❑ Comments: <br />Custody Seals <br />Ice Chest l7 <br />IntaclR Yes I]o <br />Containers 0 <br />Intact? Yes �` No� <br />None�,HD Comments: <br />All samples received? Ye No D <br />An samples containers intact,?O Na Cl Descriptions) match COC? Yes�No` ❑ <br />,�C•OC Received <br />!�' YES Q NO <br />1DatelTime 2i 2t-1`l�- <br />Temperature: A 7• � °C (C 3•.LD °C Analyst snit-lt-�VJ 2lSs <br />Emissivity: b,`1rG Container: \iG�CI Thermometer l6; k -1 -SAMPLE <br />SAMPLE CONTAINERS <br />NUMDFRS <br />1 z 3 4 5 s 1 a s to <br />QT GENERAL MINERAL! GENERAL PHYSICAL <br />PT PE UNi'RESERVF.Q <br />T INORGANIC CItF.MiCA[. MMETALSP'r <br />IN0 GAN[C CHIEMICA M TATS <br />Pr CYANIDE <br />i'T hTTROGEN FORhIS <br />1'T TOTAL SULFIDE <br />7,.Loz NITRATEO\TE /NITRITE <br />PT "TOTAL ORGi6©ICG\RRON <br />PT TOX <br />CT CHHEh1BCAL O.KI'GEN DEMAND <br />rtA PHENOLICS <br />7um1 VOA VIAL TRAVEL BLANK <br />70nd VOA VIAL <br />/,/"Tr" /� <br />T EPA 413.1 ,413.2.418.1 <br />PT ODOR <br />RADIOLOGICAL <br />BACTERIOLOGICAL <br />70 ad VOA VIAL- 507 <br />'C ECA 5118160818080 <br />T EPA 515.119150 <br />OT 525 <br />T EPA 925 TRAVELL BLANK <br />O@ <br />Lml EPA 577 <br />i0@ml EPA 531.1 <br />T EPA 548 <br />T EPA SJJ <br />T EPA 632 <br />T EPA SO ISM <br />T AMBER <br />8 OZ JAR <br />32 OZ JAR <br />SOIL SLEEVE <br />PCD VIAL <br />PLASTIC BAG <br />FERRO t 1R N <br />ENCORE <br />Comments: <br />Sample Numbering Completed By: <br />A - Actual I C = Corrected <br />i ez <br />/7 r <br />Dateffime: <br />jH:VDOCSIWP@ORAB aGCS%FORMS%SAMREC2.WPel <br />' I The results in this report apply to [he samples ana(yzec( in accordance with the chain of custody document. This ana(ytrca! report must be reproduced in its entirety. <br />All results listed in this report are for the exclusive use of the submitting party. BC Laboratories, Inc. assumes no responsibility for report alteration, separation, detachment or third party interpretation. <br />4100 Atlas Court Bakersfield, CA 93308 (661) 327-4911 FAX(661)327-1918 www.bciabs.com Page 4 of 18 <br />